Provider Demographics
NPI:1487616801
Name:KORSBERG, JANE ELKAN (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELKAN
Last Name:KORSBERG
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32700 S ROUNDHEAD DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4738
Mailing Address - Country:US
Mailing Address - Phone:440-349-3873
Mailing Address - Fax:
Practice Address - Street 1:3909 ORANGE PL
Practice Address - Street 2:
Practice Address - City:ORANGE VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44122-4481
Practice Address - Country:US
Practice Address - Phone:440-349-3873
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL3600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH51-0534794OtherEIN